Effect of cigarette smoking on the clinical outcomes of periodontal surgical procedures.

INTRODUCTION Experimental studies have revealed that nicotine upregulates the expression of receptors of advanced glycation end products and retards fibroblastic cell migration in the gingiva of smokers compared with nonsmokers, thereby inducing a proinflammatory effect. The aim of this study was to review the effect of cigarette smoking on the clinical outcomes of periodontal surgical procedures. METHODS To address the focused question, "What is the effect of cigarette smoking on clinical outcomes after periodontal surgical interventions?", databases were searched from 1968 to May 2010 using various combinations of the following key words: inflammation, mucoperiosteal flap, periodontal surgery, smoking and tobacco. The inclusion criteria included all levels of available evidence. Articles published only in the English language were evaluated, and unpublished data were not sought. RESULTS Twenty-four clinical studies were included. The duration of smoking habit ranged from at least 5 years to 27.8 years. Sixteen studies showed that reductions in probing depth and gains in clinical attachment levels were compromised in smokers in comparison with nonsmokers. Three studies showed residual recession after periodontal surgical interventions to be significantly higher in smokers compared with nonsmokers. Three case reports showed periodontal healing to be uneventful in smokers. CONCLUSION Cigarette smoking has a negative effect on periodontal wound healing after surgical interventions.